Cancer Treatment Centers of America® Feature
Juan Alzate, MD
Neurosurgeon at Cancer Treatment Centers of America® (CTCA)
Cancer is unforgiving. When neurosurgeons ply their craft they look for a classic constellation of symptoms – weight loss, fevers, night sweats, unremitting back pain, cough – indicating symptoms relating to spinal cancer. The gears of time begin to grind down.
But at Cancer Treatment Centers of America® (CTCA), the neurosurgeons are on full alert when identifying symptoms to reach a diagnosis. Juan Alzate, MD, whose father died of cancer in Colombia, works with patients who have brain or spinal cancer, as well as cancer that has spread to the brain or spine from other areas of the body.
“My overall goal for my patients is to deliver excellent care and treatment using advanced and innovative technologies in order to achieve the best possible outcome for patients with brain and spinal tumors,” says Dr. Alzate, a world-renowned neurosurgeon at CTCA®.
Dr. Alzate is a proud partner with such a reputable organization that features high-quality, state-of-the-art operating rooms and support staff. He utilizes traditional and minimally invasive surgical procedures including intricate, spinal and endoscopic cranial-based surgeries.
“By using minimally invasive surgical technologies, we are able to reduce complications and speed recovery with minimal scarring, where possible,” he says. Dr. Alzate empowers his patients with information and takes time to discuss their concerns and address their questions. He helps them understand their conditions so they can make informed decisions regarding their treatment plan.
Dr. Alzate advises that education is very important in the treatment of cancer. He often goes out into the Latino community to help spread the word about early cancer detection. “I like to enlist community members to help magnify the process of cancer detection and to encourage folks into getting screened early,’’ he says. “I look for leg pain or severe back pain. I also ask folks if they have had any severe headaches or confusion, as well as if there are any other problems besides the one being consulted for.’’
In addition to traditional cancer fighting methods, many CTCA physicians use sophisticated tools to enhance precision of care and patient safety. These tools allow surgeons to remove tumors that may otherwise have been inoperable, while preserving neurologic function.
For example, physicians at CTCA use intraoperative neuronavigation, which is an advanced MRI system to map areas of the brain responsible for important functions. This map allows the physician and operating team to precisely plan surgery to avoid damage to those important areas. Other parts of the elaborate toolkit include motor mapping and language mapping – a GPS for the brain. The surgical team uses small electrodes placed on the outer layer of the brain to stimulate the brain and areas around the tumor. That maneuver helps the team locate regions of the brain to avoid, like those areas responsible for speech and movement.
Of course, a patient’s health plays a large role in the treatment of chronic disease. According to the American Academy Neurology, obese people have a greater chance of experiencing brain cancer; furthermore, the U.S. Department of Health and Human Services Office of Minority Health reports that more than half of all Latino women are overweight or obese. Alzate instructs patients to eat a balanced diet including more fruits, vegetables and lean meats. “We are what we eat,’’ he stresses. “The best way to reduce your risk of cancer is healthy lifestyle changes. And if you are experiencing any unusual symptoms, including severe leg or back pain or headaches, it is important to speak with your doctor.”
Estilo de Vida
Ricardo Alvarez, MD, MSc
Director of Cancer Research and Breast Medical Oncologist at Cancer Treatment Centers of America® (CTCA)
Eating the right kinds of food before, during and after cancer treatment can help a patient feel better and stay stronger. A healthy diet includes eating and drinking the foods and liquids that have important nutrients for the entire body, according to Ricardo H. Alvarez, MD, MSc, Director of Cancer Research and Breast Medical Oncologist at Cancer Treatment Centers of America® (CTCA).
But lack of access to affordable healthy food has caused obesity to skyrocket for the Hispanic population, where 42 percent of all Latino adults are obese compared with 32.6 percent of obesity in whites, according to an annual report conducted by Trust for America’s Health and the Robert Wood Johnson Foundation, The State of Obesity. Dr. Alvarez points out that obesity is a critical factor in heightened cancer risk. He also is committed to educating Hispanics about cancer and the preventative steps essential to fighting this global epidemic. Cancer is the leading cause of death among Hispanics, accounting for 22 percent of deaths in 2012, according to the Cancer Facts & Figures for Hispanics/Latinos 2015-2016 published by the American Cancer Society.
“In many cases what is known about cancer prevention is evolving, which occasionally leads to conflicting prevention tips,” explains Alvarez. “However, it is well accepted that your chances of developing cancer are affected by the lifestyle choices you make.’’ Dr. Alvarez also reports that simple lifestyle changes can make a big difference, including avoiding tobacco use, eating a healthy diet filled with plenty of fruits, vegetables and whole grains; limiting processed meats; and carefully monitoring alcohol consumption.
Dr. Alvarez applauds the FDA for the approval of 13 new anticancer therapeutics, 11 new uses for previously approved anticancer therapeutics, one new diagnostic test, one new cancer screening test, and two new diagnostic imaging agents for treating cancer during 2016. An eternal optimist, Dr. Alvarez is bullish on the use of targeted agents to fight cancer. Most standard chemotherapy drugs work by killing cancer cells in the body that grow and divide quickly. Yet, these drugs can also affect other cells in the body that divide quickly and can sometimes lead to serious physical side effects.
Targeted cancer therapy drugs do not work like chemotherapy drugs, explains Dr. Alvarez. Targeted cancer drugs prevent the growth and spread of cancer by interfering with specific molecules. Cancer cells typically have many changes in their genes (DNA) that make them different from normal cells. For instance, these gene changes might allow the cell to stop working the way it should or grow and divide very quickly. These types of changes are what make a cell cancerous.
“We screen for all types of cancers, that’s why we do integrated care at CTCA®,’’ according to Dr. Alvarez, a world-renowned oncologist recognized for his contributions to the multidisciplinary management of breast cancer. At CTCA, Dr. Alvarez is part of the Breast Center for Advanced Oncology and is mainly focused on the treatment of advanced breast cancer and inflammatory breast cancer.
“I work as part of a multidisciplinary team that includes surgical oncologists, medical oncologists and radiation oncologists,” he explains. “Together, we outline a clear plan before our patients begin treatment.”
“This is a very advanced group of medical professionals who dedicate the vast majority of their time to treating breast cancer. I think being treated at a cancer center, and seeing a specialist dedicated to treating breast cancer rather than a general medical oncologist, can make a big difference for patients,’’ adds Dr. Alvarez, who spent his childhood in Argentina admiring his father’s medical career.
Dr. Alvarez admits that he wanted to be a doctor from an early age after accompanying his father on many patient visits. “I understand the challenges Hispanics face in combating serious illnesses like cancer,’’ he says.
According to Cancer Health Disparities published by the National Cancer Institute, individuals from medically underserved populations are more likely to be diagnosed with late-stage diseases that might have been treated more effectively or even cured if diagnosed earlier. Financial, physical and cultural beliefs are also barriers that prevent individuals or groups from obtaining effective health services.
But Dr. Alvarez says the fight against cancer has improved. After the Cancer Act was passed in 1971, life expectancy for all cancer patients was 49 percent. But now, that same rate has skyrocketed to 70 percent in 2016. “Research is our best defense against cancer. It powers the development of new and better ways to prevent, detect, diagnose, treat and cure a number of the many diseases we call cancer.”
Hispanics are the largest and fastest growing minority group in the U.S, and with a population of over 55 million, they accounted for 17 percent of the U.S. population in 2014. Despite having higher poverty rates, lower education, and less access to health care than non-Hispanic Whites, Latinos tend to have overall better health indicators than those of other racial/ethnic groups with whom they share socio-economic characteristics. Experts attribute this “Hispanic paradox” to a number of factors including lifestyle practices, reproductive behaviors, extended family support and a different genetic heritage. “We are controlling cancer, but we have a long way to go,’’ says Dr. Alvarez.
Director of Faith-Based Programs at Cancer Treatment Centers of America® (CTCA)
“Overcoming cancer often requires a heroic amount of physical, emotional and spiritual strength,’’ according to Reverend Percy McCray, Director of Faith-Based Programs at Cancer Treatment Centers of America®(CTCA). Rev. McCray works with dedicated pastoral staff at the five regional CTCA® hospitals. Every day, Rev. McCray helps support hospital clergy to build bridges from despair to hope. “The goal of pastoral care at CTCA is to provide an ecumenical umbrella of spiritual support for patients, family members and staff so persons of any faith can be strengthened, motivated and inspired to combat cancer,’’ he says.
In creating an environment endemic to healing and recovery, pastoral care providers are a great source of comfort for patients and families. Many patients with cancer rely on spiritual or religious beliefs and practices to help them cope with their disease. Many caregivers also rely on this type of spiritual coping.
According to Rev. McCray, each person may have different spiritual needs, depending on cultural and religious traditions. For some seriously ill patients, spiritual well-being may affect how much anxiety they feel about death. For others, it may affect what they decide about end-of-life treatments. Some patients and their family caregivers may want to talk about spiritual concerns, but may feel unsure about how to bring up the subject.
“We’ve found that doctors’ support of spiritual well-being in very ill patients helps improve their quality of life,’’ says Rev. McCray. Health care providers who treat patients coping with cancer are looking at new ways to help them with religious and spiritual concerns.
At CTCA Rev. McCray initiated development of a broad-based program, Our Journey of Hope® (OJOH), to give spiritual leaders who counsel cancer patients tools to lift their spirits and provide hope. While it involves prayer, counsel, visits and assistance, it is centered on bringing spiritual hope and help to patients and their caregivers, family and friends.
“This requires an understanding of the impact of cancer, how people react to it and how God has called us to respond,’’ he says. This ministry program was created because of the significant need within our communities.
According to the American Cancer Society, more than 12 million people in the United States are living with or have been personally diagnosed with cancer. Every year, 1.5 million more people receive a cancer diagnosis.
That means that in a church of 200 people, approximately eight people are living with cancer and two more will be diagnosed with it every year, according to OJOH.
Rev. McCray explains that the Bible-based ministry training program was developed to equip people with the tools needed to bring hope to the millions who are living with cancer.
Some of the practical tools include how cancer patients in general should be treated and approached when they are at a health care facility. Below are a few tips offered by the OJOH training program:
• Knock first on a patient’s door to see if they are ready for a visit. Some patients struggle with changing physical appearance like hair loss or weight loss.
• Never sit on the side of a patient’s bed. This is their space.
• Never pry into a person’s health condition unless you are asked to do so by the patient. Allow the patient to drive the conversation.
“We help people believe there is a better day ahead,’’ says Rev. McCray. “We believe spirituality helps patients and families find deeper meaning and experience a sense of personal growth during cancer treatment, while living with cancer and as a cancer survivor.’’
THE CTCA OUR JOURNEY OF HOPE PROGRAM ALSO HELPS:
• Decrease feelings of anger and anxiety
• Decrease feelings of loneliness
• Increase confidence in supporting cancer patients
• Overcome fear
For more information on Our Journey of Hope, please visit www.ourjourneyofhope.com.
If you’re looking for motivation to be more physically active, you may find it in a recent study that shows, in addition to its other health benefits, exercise may reduce the risk of 13 types of cancer. In the study, conducted by researchers at the National Institutes of Health and the American Cancer Society and published in the May 2016 edition of the JAMA Internal Medicine, researchers examined the physical activity levels of 1.4 million people over an 11-year period. The study gathered specific information of how vigorously and how often each participant exercised. Researchers also noted whether and when the participant was diagnosed with cancer.
Overall, participants who exercised more saw a 7 percent lower risk of developing any type of cancer than people who exercised less often. Those who were the most active (measuring in the 90th percentile) had a reduced risk of the following 13 cancer types, compared to the least active participants (measuring in the 10th percentile):
• Esophageal adenocarcinoma (42 percent lower risk)
• Liver (27 percent lower risk)
• Lung (26 percent lower risk)
• Kidney (23 percent lower risk)
• Stomach (22 percent lower risk)
• Endometrial (21 percent lower risk)
• Myeloid leukemia (20 percent lower risk)
• Myeloma (17 percent lower risk)
• Colon (16 percent lower risk)
• Head and neck (15 percent lower risk)
• Rectal (13 percent lower risk)
• Bladder (13 percent lower risk)
• Breast (10 percent lower risk)
“While we have always known that exercise is good for your health, this study shows a direct association between exercise and reduction in risk for very specific types of cancers, including some of the more aggressive types of cancers,” says Gentry Kozub, Physical Therapist at Cancer Treatment Centers of America® (CTCA). “Moderate physical activity means getting your heart rate elevated to 60 percent of your estimated heart rate maximum. What this really means is increasing your heart rate to work up a sweat.” Kozub suggests calculating your target heart rate for moderate intensity by subtracting your age from 220, then multiplying that number by 60 percent.
The study suggested that moderate exercise may help regulate hormone levels associated with an increased cancer risk, while controlling insulin levels linked to cancer growths. “The recommendations for exercise from the study are realistic and achievable,” says Kozub. She recommends spreading exercise out over the week (five days a week for 30 minutes, or six days a week for 25 minutes, etc.).
The study also found that while being overweight is a well-known risk factor for cancer, exercise appeared to help obese participants lower their risks for the disease.
Dennis Citrin, MD, PhD
Medical Oncologist at Cancer Treatment Centers of America® (CTCA)
The Johnsons are great examples of true grit. In 2007, just before Christmas, Chris Lopez Johnson received a letter stating the radiologist had found something in her recent routine mammogram. After more tests, a biopsy confirmed that she had ductal carcinoma in situ (stage 0 breast cancer).
Johnson, who lives in Winthrop Harbor, Ill., with her husband, Rick, didn’t know how to react at first. “You feel like you are floating away and watching the conversation,” she says. With the support of Rick, she underwent a lumpectomy. Afterwards, she sought an opinion at Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center (Midwestern) to see if any additional treatment would be needed. At CTCA®, Johnson chose to undergo a second lumpectomy, followed by radiation. She was supported by integrative oncology services, such as nutrition and spiritual support, to help her through her battle.
Cancer is the leading cause of death among Hispanics, as reported by the American Cancer Society. When it comes to breast cancer, Hispanics frequently have a more biologically aggressive form of breast cancer, says Dennis Citrin, MD, PhD, Medical Oncologist at CTCA at Midwestern. Because of this, Dr. Citrin explains that oncologists can meet this challenge by better defining the genomic type of breast cancer and tailoring treatment appropriately.
When should a woman be concerned she could have breast cancer? According to Dr. Citrin, the first signs of breast cancer may include a lump, skin dimpling in the breast, a bloody nipple discharge, or no symptoms at all, but something found on a mammogram. If you find you are experiencing any of these, Dr. Citrin encourages you to, “first, don’t delay in getting a diagnosis. Breast cancer can be a highly treatable disease if caught early. Second, follow your treatment plan. And third, seek professional medical advice and opinions from reputable sources.”
Today, Johnson and her husband participate in cancer awareness events to get the word out about the importance of early screening. The Johnsons also volunteer at CTCA because they value the care and compassion they received when Chris was experiencing her cancer journey. “As I am nearing the 10-year mark of survivorship, I think back to all the things I have been able to enjoy with my family and friends and I feel very blessed,” she says.
Marisa S. Benincasa, MBA
Loyalty Manger at Cancer Treatment Centers of America® (CTCA)
Steve White, LCSW
Mind-Body Therapist at Cancer Treatment Centers of America® (CTCA)
A cancer diagnosis is life changing, and making treatment decisions can be overwhelming. At Cancer Treatment Centers of America® (CTCA) patients and caregivers connect through dynamic network dubbed Cancer Fighters®.
“We are a community of people fighting cancer by nurturing, engaging and empowering one another. We share our stories, give courage and support, and inspire, help and celebrate life with one another,’’ says Marisa S. Benincasa, MBA, Loyalty Manager, who oversees the Cancer Fighters program at CTCA®.
Founded in 1990 by a group of CTCA patients, Cancer Fighters taps into the experience, knowledge and inspiration of cancer patients and caregivers across the country. The program also supports patients, caregivers and their families with resources and opportunities to find peer support.
Caregivers are those individuals helping family members or a friend through cancer treatment. “Caregiving may mean helping with daily activities such as going to the doctor or making meals. It could also mean coordinating services and care. Or it may be giving emotional and spiritual support,’’ according to Steve White, a Licensed Clinical Social Worker and Mind-Body Therapist at CTCA. His fluency in Spanish also gives him a special connection to Hispanic cancer patients.
“We work with patients to decrease stress, whether it is brought on by the cancer or other events in their lives,’’ he says. “We usually work one-on-one with patients or we work with them alongside a caregiver.’’
In the case of some Hispanic families, White says there is a tendency for families to encourage the cancer patient to stay in bed. “But we try to impress upon families that it is better for cancer patients to get up and walk around,” he says.
Both White and Benincasa point out that whether you’re younger or older, you may find yourself in a new role as caregiver. You may not have been an active part of someone’s life before, but perhaps now that they are a cancer patient, the way you support them is more active. It may be in a way in which you haven’t had much experience, or in a way that feels more intense than before. Even though caregiving may feel new to you now, White says many caregivers and family members learn more as they go through their loved one’s experience. CTCA therapists report that some of the more common situations facing caregivers may include one or more of the following:
• Patients may only feel comfortable with a spouse or partner taking care of them.
• Parents may have a hard time accepting help from their adult children.
• Adult children may not want to rely on their parents for care.
• Caregivers may have health problems themselves, making it physically and emotionally hard to take care of someone else.
Whatever your roles are now, it’s very common to feel confused and stressed at this time. “If you can, try to share your feelings with others going through the same journey you are, like our Cancer Fighters,’’ says White.
White cautions that some patients deal with procedures better than others. “Some patients become panic stricken or claustrophobic when placed in a confined space, such as certain radiation equipment. We teach patients relaxation exercises,’’ he adds. Aside from deep breathing training, CTCA cancer patients have access to talking with a counselor, activities, and laughter club. “Laughter is often the best medicine. We use activity groups such as QiGong and Tai Chi, and sprinkle in some humor to make it a fun activity,’’ White says.
Many cancer patients say that, looking back, they took too much on themselves. Or they wished they had asked for help from friends and family sooner. ‘‘Many patients, including Hispanic patients, feel that they are a burden to relatives and friends and are hesitant to ask for help for such chores as cooking and cleaning,’’ White says.
Medical expertise is a key part of cancer treatment, but it is not enough. You need to build a cancer support team. Here are some Cancer Fighters tips that will help you succeed:
Don’t be afraid to ask for help – You may be surprised at how willing people and family are to help in your cancer journey.
Build a team – You can’t do it all alone.
Bring a partner to appointments – Ask a friend or family member to accompany you to treatment sessions for emotional support.
Figure out what you need – People want to help but they need to know what you need. Do you need help with the children? Can you cook your own meals? Make a list of what you need and spread the work load to friends and family.
Talk to your children – It’s better for them to find out now about your cancer than learning about it from other sources.
Designate a surrogate – Make certain you have someone to handle your legal affairs as you deal with your cancer treatment regimen.
For more information on the Cancer Fighters program, please visit www.cancerfighter.com